Laparoscopic vs open appendectomy in appendicitis

Laparoscopic appendectomy offers a significant advantage over open appendectomy in quality of life scores at 2 weeks but not for other studied parameters, reports this month's Annals of Surgery.

fiogf49gjkf04

The value of laparoscopy in appendicitis is not established, and studies that have researched this suffer from multiple limitations.

Dr Namir Katkhouda and colleagues compared the safety and benefits of laparoscopic versus open appendectomy.

The researchers designed a prospective randomized double blind study.

The research team analyzed 247 patients following either laparoscopic or open appendectomy.

A standardized wound dressing was applied blinding both patients and independent data collectors.

The team standardized surgical technique among 4 surgeons.

The main outcome measures were postoperative complications.

Secondary outcome measures included evaluation of pain and activity scores at base line preoperatively and on every postoperative day.

The researchers also assessed resumption of diet and length of stay.

Overall complication rate was 19% in the laparoscopic vs 17% in the open groups

Annals of Surgery

Activity scores and quality of life were assessed on short-term follow-up.

The research team observed no mortality.

The team found that the overall complication rate was similar in both groups, at 19% in the laparoscopic and 17% in the open groups.

However, the team noted that some early complications in the laparoscopic group required a reoperation.

Operating time was significantly longer in the laparoscopic group, at 80 minutes versus 60 minutes in the open groups.

The researchers observed no difference in the pain scores and medications, resumption of diet, length of stay, or activity scores.

At 2 weeks, the researchers found no difference in the activity or pain scores.

The team noted that physical health and general scores on the short-form 36 quality of life assessment forms were significantly better in the laparoscopic group.

Appendectomy for acute or complicated appendicitis had similar complication rates, regardless of the technique.

Dr Katkhouda's team concludes, “Unlike other minimally invasive procedures, laparoscopic appendectomy did not offer a significant advantage over open appendectomy in all studied parameters except quality of life scores at 2 weeks.”

“It also took longer to perform.”

“The choice of the procedure should be based on surgeon or patient preference.”